Healthcare Provider Details

I. General information

NPI: 1457876732
Provider Name (Legal Business Name): EUROPEAN FOOT & ANKLE SURGICAL CARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W BELMONT AVE
CHICAGO IL
60641-4130
US

IV. Provider business mailing address

5501 W BELMONT AVE
CHICAGO IL
60641-4130
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-0106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: VADIM GOSHKO
Title or Position: PRESIDENT
Credential: DPM
Phone: 773-205-0106